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In the world of health care, hospitals are held accountable for worst-case scenarios. While it may not be the fault -- or even the responsibility -- of a medical institution or an individual, a mortality rate provides a clear and objective benchmark of health-care outcomes.
But medical institutions also track and report numerous other measures -- including the safety and timeliness of their response, readmission rates, and effectiveness of care. Those metrics not only hold the field accountable but also foster transparency and enable health-care leaders to improve their institutions’ performance over time.
In the field of oncology, for example, we report not just the survival rate but also intermediate metrics like remission, recurrence and even patient satisfaction scores. It’s a dynamic process, rooted in a belief that we cannot wait for quality to be fully defined before we act to improve the lives of our patients.
Higher education, like health care, also tracks and is held accountable for the worst-case scenario. Higher education’s mortality rate equivalent is the cohort default rate, or CDR, which measures the percentage of the borrowers at a higher education institution who entered repayment and subsequently defaulted on their student loans within three years. Released each year by the U.S. Department of Education, the CDR tells the percentage of students whom our institutions have in some way let down. The lives of today’s students are increasingly complex. Their reasons for leaving an institution and possibly defaulting are the result of a multitude of factors, including those outside the scope of their relationship with their college or university. Institutions still, however, have the obligation to support students through these challenges -- whether they be academic, financial or a result of life circumstances.
As a nursing professor and health-systems administrator who has also become a higher education policy maker, I have always found it odd that -- despite the similarities between medicine and postsecondary education -- our colleges and universities are not asked to report on measures that should be evident long before a student (or institution) faces the worst-case scenario.
For example, reporting on loan repayment, as opposed to simply default rates, would help policy makers understand the percentage of borrowers who make at least one payment toward their loan principal over a period of time. Armed with information about whether borrowers are repaying their debt or making payments only on the interest earned, students -- as well as federal, state and local policy makers -- could make better-informed decisions based on much more timely information about the return on investment for specific programs.
Gathering and reporting loan repayment rate data would also provide early and actionable signals about institutions that might have a default problem. That could create time for campus leaders to intervene with their former students and take steps to reform their academic programs. Campuses could reach out to former students through phone calls, technology platforms and other forms of correspondence to determine what is preventing them from making payments on their loans. Campuses could work with the loan servicer to ensure that the former student is aware of all of their options for repayment.
It wouldn’t be the first time policy makers rethought this measure. Before the last rewrite of the Higher Education Act, for example, colleges were accountable for defaults that occurred within two years of a student leaving an institution. If a borrower defaulted after the two-year window, institutions were held harmless. But defaults within the two-year window were rare, if not impossible, rendering the cohort default rate a toothless accountability tool -- and a poor measure of quality. With better data capabilities and an updated policy framework, Congress moved the bar to three years in 2008. It’s time to evolve again.
Some people may argue that holding an institution accountable for a student’s inability to repay loans is unfair, or even punitive, given the unpredictable impact of broader economic dynamics within a given state or region. But such arguments are the higher education equivalent of hospitals blaming their patients.
What’s more, they deprive both students and policy makers of the very data necessary to understand whether our educational priorities are aligned with a state’s rapidly changing labor market. And they strip institutions of the data they need to explain and claim their economic impact.
We cannot change higher education’s outcomes by focusing on our worst-case scenarios alone. The data now exist to make the shift from reporting student loan mortality toward capturing and sharing metrics that matter before default occurs. The conversations around outcomes and metrics in higher education, like health care, have to evolve if we are to improve our collective results and change the odds of success for today’s students.
